Towards an optimized strategy for HIV screening in West Africa

06 December 2017
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Are strategies of screening for HIV infection in Ivory Coast effective enough to stop the AIDS epidemic? ANRS study DOD-CI is examining HIV screening strategies in Ivory Coast by means of a national survey among 4000 members of the general population as well as observations of medical consultations. This study's first results reveal that carers report reluctance and difficulty in offering HIV tests at medical appointments, in a country where one in two people have never done such a test in their lives. The results also show that more than one-third of those surveyed could have been screened at an appropriate medical visit or on their own initiative. The study is coordinated by Mariatou Koné (Institut d’Ethnosociologie de l’Université Félix Houphouët Boigny d’Abidjan) and Joseph Larmarange (Institut de recherche pour le développement, IRD) in partnership with the ANRS Ivory Coast site (PACCI program) and the École Nationale Supérieure de Statistique et d'Économie Appliquée d’Abidjan. The first study findings will be presented at the 19th International Conference on AIDS and STIs in Africa (ICASA 2017), which will be held on December 4-9, 2017 in Abidjan, Ivory Coast.
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Screening is the first link in the chain of the 90-90-90 treatment target1 set by UNAIDS to help put an end to the AIDS epidemic. To improve access to HIV testing, Ivory Coast decided in 2009, in line with WHO guidelines, to offer screening for HIV infection to all patients consulting a doctor, for whatever reason. Since 2013, more targeted screening strategies have been implemented and against this backdrop ANRS study DOD-CI has been coordinated by Mariatou Koné (Institut d’Ethnosociologie de l’Université Félix Houphouët Boigny d’Abidjan) and Joseph Larmarange (Institut de recherche pour le développement, IRD), in partnership with ANRS Ivory Coast site (PACCI program) and the École Nationale Supérieure de Statistique et d'Économie Appliquée d’Abidjan. This study has brought together a multidisciplinary research team to conduct six complementary surveys designed to examine the different screening strategies in place in Ivory Coast. The first findings will be presented at the 19th International Conference on AIDS and STIs in Africa (ICASA 2017), which will be held on December 4-9, 2017 in Abidjan, Ivory Coast.

Difficulties encountered by carers in offering HIV tests to all patients

Over 200 medical appointments were observed in a qualitative study conducted between June 2015 and April 2016 in three general medicine departments in Ivory Coast, and 37 health care professionals were interviewed regarding their experience with HIV screening. Only one in five patients was offered a screening test during his or her appointment. This low rate is explained by the carers’ fear that patients will refuse the test, mistrust their doctor, or walk out. HIV screening involves very specific procedures (dedicated registries, separate prescriptions, pre- and post-test counseling, obtaining informed consent, etc.). This is why health care professionals see HIV testing as extra work that is neither acknowledged nor valued, do not consider it a priority, and think it is unjustified in general medicine appointments, unless infection is clinically suspected. Lastly, when an HIV test is done, more often than not it is prescribed without first providing patients with explicit information
    
Missed opportunities and failed procedures

ANRS study DOD-CI also comprised a vast quantitative study in the form of a telephone survey in a representative sample of the Ivorian population comprising 3882 people interviewed between February and November 2017. Half of those questioned had been tested for HIV in the last 5 years. Initiation of testing by a health care professional remains suboptimal in certain situations that lend themselves to an offer of HIV screening. For example, only one-quarter of men and women who reported seeing a doctor because of a sexually transmitted disease were offered an HIV test. Also, only 74% of women at a prenatal visit and 34% of the men accompanying them were offered an HIV test. The study also showed that 15% of those surveyed had, on their own initiative, already sought screening at some point in their lives, but it came to nothing. These initiatives largely failed because of fear of the test results, but also sometimes because of a lack of time or too long a wait. Therefore, over one-third of the people in this study who had never undergone screening could have done so at an appropriate medical visit or by taking the initiative themselves.

The findings of ANRS study DOD-CI show that there are obstacles to HIV testing at several levels, social and political as well as institutional and organizational. ANRS Director Professor François Dabis considers that “These results show that despite an effort to put in place an optimal screening strategy to end the AIDS epidemic, there are still obstacles in many countries, notably in sub-Saharan Africa. These findings should encourage the continuation and intensification of information campaigns and of awareness raising among health care professionals, as well as the simplification of the conditions in which screening for HIV infection is done.” Joseph Larmarange adds that “lt is also necessary to ensure that when people decide to seek testing, they are able see it through to completion, so as to be treated medically if needed or to receive advice on prevention.” »

Founded in 1988, the French Research Agency ANRS brings together researchers from different fields and institutions in the developed world and resource-limited countries to work on scientific questions regarding HIV/AIDS or viral hepatitis. The ANRS funds research projects approved by international expert committees. It oversees projects from conception to completion and ensures that the results are used for the benefit of the populations concerned. Its annual budget of around 45 million euros is provided by the ministries in charge of Research and Health. Since 2012 it has been an autonomous agency of Inserm (French National Institute of Health and Medical Research).

 

1 Objectif 90 90 90 fixé par l’OMS pour mettre fin à l’épidémie de Sida d’ici 2030 : A l’horizon 2020, 90% des personnes vivant avec le VIH connaissent leur statut sérologique. A l’horizon 2020, 90% de toutes les personnes infectées par le VIH dépistées reçoivent un traitement antirétroviral durable. A l’horizon 2020, 90% des personnes recevant un traitement antirétroviral ont une charge virale durablement supprimée.

Sources:
« Il y a des Conseillers Communautaires Payés pour ça ! ».
Les Réticences des Soignants à la Proposition Systématique d'un test VIH en Consultation de Médecine Générale. Le Cas de la Côte d'Ivoire
Communication Poster jeudi 7 décembre lors de la conférence ICASA à Abidjan

Carillon Séverine1, Bekelynck Anne2, Kouadio Alexis3, Assoumou Nelly3, Danel Christine4, Ouantchi Honoré3, Larmarange Joseph1, DOD-CI ANRS 12323
1Ceped UMR 196 (Paris Descartes-IRD) SageSud ERL INSERM 1244, IRD, Paris, France, 2Programme PACCI, Site ANRS, Abidjan, Côte d'Ivoire, 3Institut d'Ethno Sociologie (IES), Abidjan, Côte d'Ivoire, 4INSERM, 1219, Bordeaux, France

Comment améliorer le dépistage du VIH en population générale dans un contexte d’épidémie mixte? Résultats préliminaires de l’étude DOD-CI (ANRS 12323) en Côte d’Ivoire.
Communication orale Mercredi 6 décembre 2017 lors de la conférence ICASA à Abidjan

Maxime INGHELS1, Arsène Kra KOUASSI2, Anne BEKELYNCK3, Séverine CARILLON1, Lazare SIKA2, Christine DANEL3, Joseph LARMARANGE1.
1Ceped UMR 196 (Paris Descartes-IRD) SageSud ERL INSERM 1244, IRD, Paris, France, 2 École Nationale Supérieure de Statistique et d'Économie Appliquée d’Abidjan, ENSEA, Abidjan, Côte d’Ivoire, 3Programme PACCI, Site ANRS, Abidjan, Côte d'Ivoire